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Out-of-hospital births in California 1991–2011



We investigated the frequencies and characteristics of out-of-hospital births in a 20-year period in California, where 1 of every 7 births in the United States occurs.

Study Design:

Birth certificate records of deliveries in California between 1991 and 2011 were analyzed. Out-of-hospital births were assessed by year, parity, gestational age and maternal race/ethnicity.


In the 20-year period there were 10 593,904 deliveries, of which 46 243 occurred out of hospital (0.44%). Out-of-hospital births decreased from 0.54 to 0.38% per year between 1991 and 2004, and increased from 0.41% in 2005 to 0.61% in 2011. In contrast, preterm out-of-hospital births declined from 7.2% in 2006 to 5.0% in 2011. The frequency of vaginal birth after cesarean in the out-of-hospital birth cohort increased from 1.2% (n=19) in 1996 to 4.2% (n=82) in 2011.


California birth records from a 20-year period show an increase in out-of-hospital births from years 2005 to 2011, following a period of decline from 1991 to 2004.

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  1. Grunebaum A, McCullough LB, Sapra KJ, Brent RL, Levene MI, Arabin B et al. Apgar score of 0 at 5minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. Am J Obstet Gynecol 2013; 209 (323): e321–e326.

    Google Scholar 

  2. Grunebaum A, McCullough LB, Sapra KJ, Brent RL, Levene MI, Arabin B et al. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009. Am J Obstet Gynecol 2014; 211 (390): e391–e397.

    Google Scholar 

  3. Snowden JM, Tilden EL, Snyder J, Quigley B, Caughey AB, Cheng YW . Planned out-of-hospital birth and birth outcomes. N Engl J Med 2015; 373: 2642–2653.

    Article  CAS  Google Scholar 

  4. Visser GH . Obstetric care in the Netherlands: relic or example? J Obstet Gynaecol Can 2012; 34: 971–975.

    Article  Google Scholar 

  5. Grunebaum A, Chervenak FA . Out-of-hospital births in the United States 2009-2014. J Perinat Med 2016; 44 (7): 845–849.

    PubMed  Google Scholar 

  6. MacDorman MF, Matthews TJ, Declercq E . Trends in out-of-hospital births in the United States, 1990-2012. NCHS Data Brief 2014; 144 1–8.

    Google Scholar 

  7. Grunebaum A, McCullough LB, Arabin B, Brent RL, Levene MI, Chervenak FA . Neonatal mortality of planned home birth in the United States in relation to professional certification of birth attendants. PLoS ONE 2016; 11: e0155721.

    Article  Google Scholar 

  8. Cheng YW, Snowden JM, King TL, Caughey AB . Selected perinatal outcomes associated with planned home births in the United States. Am J Obstet Gynecol 2013; 209: 325.e321–8.

    Article  Google Scholar 

  9. MacDorman MF, Declercq E . Trends and characteristics of United States out-of-hospital births 2004-2014: new information on risk status and access to care. Birth 2016; 43: 116–124.

    Article  Google Scholar 

  10. American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. Committee opinion no. 669: planned home birth. Obstet Gynecol 2016; 128: e26–e31.

    Article  Google Scholar 

  11. de Jonge A, Geerts CC, van der Goes BY, Mol BW, Buitendijk SE, Nijhuis JG . Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases. BJOG 2015; 122: 720–728.

    Article  CAS  Google Scholar 

  12. Hutton EK, Reitsma AH, Kaufman K . Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth 2009; 36: 180–189.

    Article  Google Scholar 

  13. Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK . Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009; 181: 377–383.

    Article  Google Scholar 

  14. Grunebaum A, McCullough LB, Brent RL, Arabin B, Levene MI, Chervenak FA . Perinatal risks of planned home births in the United States. Am J Obstet Gynecol 2015; 212: 350.e351–6.

    Google Scholar 

  15. Cox KJ, Bovbjerg ML, Cheyney M, Leeman LM . Planned home VBAC in the United States, 2004-2009: outcomes, maternity care practices, and implications for shared decision making. Birth 2015; 42: 299–308.

    Article  Google Scholar 

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This work was supported by the March of Dimes Prematurity Research Center at Stanford University and the Stanford Child Health Research Institute.

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Correspondence to A I Girsen.

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The authors declare no conflict of interest.

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This work was presented as a poster at the Society of Maternal-Fetal Medicine’s 36th annual meeting at Atlanta, GA, in February, 2016.

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Girsen, A., Mayo, J., Lyell, D. et al. Out-of-hospital births in California 1991–2011. J Perinatol 38, 41–45 (2018).

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